A Retrospective Cohort study: The Mortality Rate of Patient with Acute Cholangitis Performing Endoscopic Retrograde Cholangiopancreatography Within and After 48 Hours.
Objective: To study the mortality rate of patients with acute cholangitis grade I-III in early and late Endoscopic Retrograde Cholangiopancreatography (ERCP)
Methods: Analyzed 162 patients who were diagnosed with acute cholangitis and underwent ERCP procedure for biliary drainage in Uttaradit Hospital from January 1st, 2015–June 30th, 2022. Patient’s data were retrospectively obtained from ICD-10 medical records. Patients were classified into severity grading by Tokyo guidelines 2018 and divided into 2 groups, 68 patients with the early ERCP group (ERCP performed within the first 48 hours after admission) and 94 patients with the late ERCP group (ERCP performed after the first 48 hours after admission). Mortality rates of patients with different severity were compared between these 2 groups. All data were analyzed by descriptive and analytic statistics.
Results: Patients with acute cholangitis in grade III in early ERCP had lower mortality rate than late ERCP about 0.75 times (95% CI 0.093-0.599, p=0.785) with no statistically significant difference. The overall mortality was not significantly different between the early ERCP group and the late ERCP group.
Conclusion: Patients with acute cholangitis in early and late ERCP have no difference with mortality rate in each severity.
Keywords: Mortality rate, Acute cholangitis, Endoscopic Retrograde Cholangiopancreatography
An Z, Braseth AL, Sahar N. Acute Cholangitis. Gastroenterol Clin North Am. 2021 Jun;50(2):403–14.
Athigakunagorn, J., Rujitanon, P., Jaseanchiun, W., & Kasetsuwan , P. (2021). Does the Timing of ERCP Affect to The Outcomes of Acute Cholangitis?. Journal of the Association of General Surgeons of Thailand under the Royal of Patronage of HM the King, 6(2),43–52.
Du L, Cen M, Zheng X, Luo L, Siddiqui A, Kim JJ. Timing of Performing Endoscopic Retrograde Cholangiopancreatography and Inpatient Mortality in Acute Cholangitis: A Systematic Review and Meta-Analysis. Clin Transl Gastroenterol. 2020 Mar;11(3):e00158.
Hou LA, Laine L, Motamedi N, et al. Optimal timing of endoscopic retrograde cholangiopancreatography in acute cholangitis. J Clin Gastroenterol 2017;51:534–8.
Iqbal U, Khara HS, Hu Y, et al. Emergent versus urgent ERCP in acute cholangitis: a systematic review and meta-analysis. Gastrointest Endosc. 2020;91: 753e760.e4.
Kalaitzakis, E. (2016). All-cause mortality after ERCP. Endoscopy, 48(11), 987–994. https://doi.org/10.1055/s-0042-111319
Khashab MA, Tariq A, Tariq U, et al. Delayed and unsuccessful endoscopic retrograde cholangiopancreatography are associated with worse outcomes in patients with acute cholangitis. Clin Gastroenterol Hepatol 2012;10:1157–61.
Kimura Y, Takada T, Kawarada Y, Nimura Y, Hirata K, Sekimoto M, et al. Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg. 2007 Jan;14(1):15–26.
Kiriyama S, Kozaka K, Takada T, et al. Tokyo guidelines 2018: Diagnostic criteria and severity grading of acute cholangitis (with videos). J Hepatobiliary Pancreat Sci 2018;25:17–30.
Ministry of Public Health. Acute Cholangitis. (n.d.). Retrieved July 13, 2022, from https://cmi.moph.go.th/isp/sp_surg/index?menu_id=3
Mulki, R., Shah, R., & Qayed, E. (2019). Early vs late endoscopic retrograde cholangiopancreatography in patients with acute cholangitis: A nationwide analysis. World Journal of Gastrointestinal Endoscopy, 11(1), 41–53. https://doi.org/10.4253/wjge.v11.i1.41
Navaneethan, U., Gutierrez, N. G., Jegadeesan, R., Venkatesh, P. G. K., Butt, M., Sanaka, M. R., Vargo, J.J.,& Parsi, M. A. (2013). Delay in performing ERCP and adverse events increase the 30-day readmission risk in patients with acute cholangitis. Gastrointestinal Endoscopy, 78(1),81–90. https://doi.org/10.1016/j.gie.2013.02.003
Parikh MP,Wadhwa V, Thota PN, et al. Outcomes associated with timing of ERCP in acute cholangitis secondary to choledocholithiasis. J Clin Gastroenterol 2018;52:97–102.
Park, C. S., Jeong, H. S., Kim, K. B., Han, J.-H., Chae, H. B., Youn, S. J., & Park, S. M. (2016). Urgent ERCP for acute cholangitis reduces mortality and hospital stay in elderly and very elderly patients. Hepatobiliary & Pancreatic Diseases International, 15(6), 619–625. https://doi.org/10.1016/S1499-3872(16)60130-3
Schneider, J., Hapfelmeier, A., Thöres, S., Obermeier, A., Schulz, C., Pförringer, D., Nennstiel, S., Spinner, C., Schmid, R. M., Algül, H., Huber, W., & Weber, A. (2016). Mortality Risk for Acute Cholangitis (MAC): A risk predictionmodel for in-hospital mortality in patients with acute cholangitis. BMC Gastroenterology, 16(1), 15. https://doi.org/10.1186/s12876-016-0428-1
Schwed AC, Boggs MM, Pham XBD, et al. Association of admission laboratory values and the timing of endoscopic retrograde cholangiopancreatography with clinical outcomes in acute cholangitis. JAMA Surg 2016;151:1039–45.
Seo YJ, Hadaya J, Sareh S, Aguayo E, de Virgilio CM, Benharash P. National trends and outcomes in timing of ERCP in patients with cholangitis. Surgery. 2020 Sep;168(3):426–33.
Sokal A, Sauvanet A, Fantin B, de Lastours V. Acute cholangitis: Diagnosis and management. J Visc Surg. 2019 Dec;156(6):515–25.
Tan M, Schaffalitzky de Muckadell OB, Laursen SB. Association between early ERCP and mortality in patients with acute cholangitis. Gastrointest Endosc 2018;87:185–92
How to Cite
Copyright (c) 2022 Health Science Clinical Research
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The names and email addresses entered in this journal site will be used exclusively for the stated purposes of this journal and will not be made available for any other purpose or to any other party.